Title:Effectiveness and Safety of Immunosuppressive Drug Therapy for Neuromyelitis
Optica Spectrum Disorders: An Overview of Meta-Analyses and
Systematic Reviews
Volume: 21
Issue: 8
Author(s): Yuan Luo, Yuqian Deng, Haiye Ran, Lei Yu, Caili Ma, Liping Zhao*Yunchen Li*
Affiliation:
- The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, 410011, China
- The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, 410011, China
Keywords:
Immunosuppressive drug therapy, neuromyelitis optica spectrum disorders NMOSD, drug effectiveness and safety, overview, GRADE, central nervous system.
Abstract:
Objective: This study aims to provide an overview of meta-analyses and systematic reviews
on the effectiveness and safety of immunosuppressive drug therapy for neuromyelitis optica spectrum
disorders (NMOSD) by evaluating the methodological quality and reporting quality of reviews.
Methods: The Chinese National Knowledge Infrastructure (CNKI), WanFang Data, China Science and
Technology Journal Database, Web of Science, the Cochrane Library, PubMed, and Embase databases
were searched to collect systematic reviews or meta-analyses on the effectiveness and safety of immunosuppressive
therapy for NMOSD from inception to December 2, 2021. Two researchers independently
screened reviews and extracted data. Any differences in the procession of review assessment
between the two researchers were re-evaluated, and the disagreement was resolved by discussion
with other researchers. The following data were extracted: author, year of publication, the country
where the study was conducted, study type, the number of included studies, sample size, risk bias
tools, medication of immunosuppressive therapy, and main outcomes. Then, the AMSTAR-2, which is
a critical appraisal tool for systematic reviews (2nd edition), and Grades of Recommendation, Assessment,
Development and Evaluation (GRADE) were used to evaluate the methodological quality and
reporting quality of evidence. A comprehensive analysis was conducted on the outcomes for all included
reviews.
Results: A total of 15 reviews were included. Of the included reviews, 3 were systematic reviews, 7
were meta-analyses, and 5 were systematic reviews and meta-analyses. According to the AMSTAR-2
criteria, 6 studies had high quality, 1 study had moderate quality, 4 studies had low quality, and 4 studies
had critically low quality. Based on the GRADE, neither evidence quality for effectiveness nor
safety was high.
Conclusion: Immunosuppressive drug therapy is effective for patients with NMOSD, but its safety is
controversial. Due to the poor quality of evidence, reliability needs to be considered. Thus, large sample,
multi-center, double-blind, randomized controlled studies are still needed in the future.
